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自发性冠状动脉夹层中的抗凝与抗血小板治疗难题。

The Conundrum of Anticoagulation and Antiplatelet Therapy in Spontaneous Coronary Artery Dissection.

机构信息

Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.

Division of Cardiology, SUNY Upstate Medical University, Syracuse, NY, USA.

出版信息

J Investig Med High Impact Case Rep. 2022 Jan-Dec;10:23247096221097541. doi: 10.1177/23247096221097541.

DOI:10.1177/23247096221097541
PMID:35546090
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9112293/
Abstract

Spontaneous coronary artery dissection (SCAD) is a relatively rare and frequently misdiagnosed disease. The current knowledge of its pathophysiology and management is limited and based mostly on hypotheses. We present a patient with recurrent SCAD whose condition worsened soon after discontinuation of anticoagulation, prompting us to question the current management and review the evidence about pathophysiology, anticoagulation, and antiplatelet therapy.

摘要

自发性冠状动脉夹层 (SCAD) 是一种相对罕见且经常被误诊的疾病。目前对其病理生理学和治疗的认识有限,主要基于假设。我们介绍了一位反复发生 SCAD 的患者,在停止抗凝治疗后不久病情恶化,这促使我们质疑当前的治疗方法,并回顾关于病理生理学、抗凝和抗血小板治疗的证据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0911/9112293/a6e138d8def5/10.1177_23247096221097541-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0911/9112293/9c6125455944/10.1177_23247096221097541-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0911/9112293/a6e138d8def5/10.1177_23247096221097541-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0911/9112293/9c6125455944/10.1177_23247096221097541-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0911/9112293/a6e138d8def5/10.1177_23247096221097541-fig2.jpg

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本文引用的文献

1
Pathophysiology of Spontaneous Coronary Artery Dissection Determines Anticoagulation Strategy.自发性冠状动脉夹层的病理生理学决定抗凝策略。
Cureus. 2021 Aug 25;13(8):e17437. doi: 10.7759/cureus.17437. eCollection 2021 Aug.
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Rationale and design of the BA-SCAD (Beta-blockers and Antiplatelet agents in patients with Spontaneous Coronary Artery Dissection) randomized clinical trial.BA-SCAD(自发性冠状动脉夹层患者中β受体阻滞剂和抗血小板药物)随机临床试验的原理和设计。
Rev Esp Cardiol (Engl Ed). 2022 Jun;75(6):515-522. doi: 10.1016/j.rec.2021.08.003. Epub 2021 Sep 22.
3
Antiplatelet therapy in patients with conservatively managed spontaneous coronary artery dissection from the multicentre DISCO registry.
保守治疗自发性冠状动脉夹层患者的抗血小板治疗:多中心 DISCO 注册研究。
Eur Heart J. 2021 Aug 31;42(33):3161-3171. doi: 10.1093/eurheartj/ehab372.
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Spontaneous Coronary Artery Dissection: Pathophysiological Insights From Optical Coherence Tomography.自发性冠状动脉夹层:光学相干断层成像的病理生理学见解。
JACC Cardiovasc Imaging. 2019 Dec;12(12):2475-2488. doi: 10.1016/j.jcmg.2019.01.015. Epub 2019 Mar 13.
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Natural History of Spontaneous Coronary Artery Dissection With Spontaneous Angiographic Healing.自发性冠状动脉夹层的自然病史与自发性血管造影愈合。
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Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association.自发性冠状动脉夹层:科学现状:美国心脏协会的科学声明。
Circulation. 2018 May 8;137(19):e523-e557. doi: 10.1161/CIR.0000000000000564. Epub 2018 Feb 22.
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Spontaneous Coronary Artery Dissection Associated With Pregnancy.自发性冠状动脉夹层与妊娠相关。
J Am Coll Cardiol. 2017 Jul 25;70(4):426-435. doi: 10.1016/j.jacc.2017.05.055.
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Spontaneous Coronary Artery Dissection as a Cause of Acute Myocardial Infarction in Young Female Population: A Single-center Study.年轻女性群体中自发性冠状动脉夹层作为急性心肌梗死病因的单中心研究
Chin Med J (Engl). 2017 Jul 5;130(13):1534-1539. doi: 10.4103/0366-6999.208245.
10
Prognostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: A report from the Angina Pectoris-Myocardial Infarction Multicenter Investigators in Japan.年轻女性急性心肌梗死患者自发性冠状动脉夹层的预后影响:来自日本心绞痛-心肌梗死多中心研究者的报告
Int J Cardiol. 2016 Mar 15;207:341-8. doi: 10.1016/j.ijcard.2016.01.188. Epub 2016 Jan 14.